Our Mission is to practice high quality medicine, maximize the gifts of our team, and give excellent service to enhance the relationship between you and your pet.

Wednesday, January 22, 2014

Case Study of the Month

Fido, a 10 lb, 1 year old Jack Russell Terrier was presented
to us after ingestion of some Nicotine gum.
With the ingestion of this type of gum in dogs we worry about TWO
different toxicities, nicotine and a sugar called Xylitol. A physical examination was performed and all
was within normal limits.

Fido's blood
work was all within normal limits as well.
The idea behind bringing pets into the clinic after toxin ingestion is
to decontaminate or help them vomit ASAP to prevent absorption into the blood
stream, along with controlling any symptoms as a result of ingestion. Pets are hospitalized in order to monitor
them for the development of symptoms as a result of toxin ingestion. Outlined below were the steps taken in Fido's
case:

Step 1: Since
ingestion occurred less than 1 hour prior to Fido’s arrival and the patient was
stable, we attempted to make him vomit to rid the stomach of its contents and
prevent absorption into his blood stream. We gave Fido several doses of hydrogen peroxide. With no such luck we tried another emetic agent
called apomorphine, which can only be obtained at a veterinary clinic. Unfortunately, we were unable to induce
vomiting.

Step 2: Since there
is no antidote for either Nicotine or Xylitol toxicity, the next step is to
give the patient activated charcoal.
This is performed if ingestion of the toxic substance occurred over an
hour after presentation or after the patient stops vomiting. Activated charcoal binds to the toxin and
prevents absorption from the gut. It is
recommended that multiple doses be given.

Step 3: Fido was then
put on intravenous fluids to flush/filter out the toxin (diuresis) more
quickly.

Step 4: Hospitalization and observation for any clinical
signs associated with either toxin exposure as listed below was the final step
for Fido.

·Nicotine initially causes excitement, excess salivation,
vomiting, diarrhea, and/or muscle tremors.
Symptoms can rapidly progress to muscle weakness, depression, shallow
respiration and paralysis. The ingestion
of this toxin can lead to death because the respiratory muscles can't do their
job. The lethal dose is very little =
2-3mg/kg. In Fido's case 3 pieces of gum
could have been lethal!

·Xylitol causes a drop in blood sugar less than
60 minutes after ingestion causing depression, lethargy/weakness, muscle tremors,
coma and possibly seizure. This toxin
causes liver damage within 8-12 hours after ingestion leading to vomiting,
diarrhea, seizures and possibly death.

Outcome: Fido was
very fortunate and he never showed any adverse symptoms as a result of the toxin
ingestion due to our fast action in decontamination. His blood sugar remained normal and we kept
him on fluids in the hospital for 24 hours.
He was released to his owners the next day. We followed up a week later to check blood
work to make sure his liver wasn't affected by the Xylitol. His lab work remained normal! Fido is continuing to live a happy and
healthy life with his loving family!